(F)utility of urine Bence Jones proteins for “routine” screening for plasma cell dyscrasia
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Malvinder S. Parmar
Abstract
Testing urine for Bence Jones Protein (BJP) had been a time old procedure used for screening and monitoring of monoclonal disorders since its description. However, has poor sensitivity and despite advances in diagnostic methods of monoclonal disorders it is being continued to be requested in individuals for evaluation of myeloma or plasma cell disorders. Effective utilization and minimizing untimely or unnecessary investigations is important in the evaluation and management of any medical condition. Though, we are hard-wired during our education with some “trigger” or “peculiar” words that make us jump to actions too quickly, without comprehending the actual problem. Supporting evidence is presented to avoid reflexive use of multiple tests and utilize tests that improve utilization, reduce waste, and uphold the Choosing Wisely principles in providing optimal care to the patients.
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Research funding: None declared.
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Author contributions: The author has accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The author states no conflict of interest.
References
1. Steensma, DP, Kyle, RA. A history of the kidney in plasma cell disorders. Contrib Nephrol 2007;153:5–24. https://doi.org/10.1159/000096757.Suche in Google Scholar
2. Basnayake, K, Stringer, SJ, Hutchison, CA, Cockwell, P. The biology of immunoglobulin free light chains and kidney injury. Kidney Int 2011;79:1289–301. https://doi.org/10.1038/ki.2011.94.Suche in Google Scholar
3. Doshi, M, Lahoti, A, Danesh, FR, Batuman, V, Sanders, PW, American Society of Nephrology Onco-Nephrology Forum. Paraprotein-related kidney disease: kidney injury from paraproteins-what determines the site of injury?. Clin J Am Soc Nephrol 2016;11:2288–94. https://doi.org/10.2215/cjn.02560316.Suche in Google Scholar
4. Katzmann, JA, Kyle, RA, Benson, J, Larson, DR, Snyder, MR, Lust, JA, et al.. Screening panels for detection of monoclonal gammopathies. Clin Chem 2009;55:1517–22. https://doi.org/10.1373/clinchem.2009.126664.Suche in Google Scholar
5. Katzmann, JA, Dispenzieri, A. Screening algorithms for monoclonal gammopathies. Clin Chem 2008;54:1753–5. https://doi.org/10.1373/clinchem.2008.116400.Suche in Google Scholar
6. Katzmann, JA, Dispenzieri, A, Kyle, RA, Snyder, MR, Plevak, MF, Larson, DR, et al.. Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc 2006;81:1575–8. https://doi.org/10.4065/81.12.1575.Suche in Google Scholar
7. Gwathmey, TM, Willis, MS, Tatreau, J, Wang, S, McCudden, CR. Clinical relevance of trace bands on serum electrophoresis in patients without a history of gammopathy. EJIFCC 2015;26:114–24.Suche in Google Scholar
8. Pretorius, CJ. Screening immunofixation should replace protein electrophoresis as the initial investigation of monoclonal gammopathy: point. Clin Chem Lab Med 2016;54:963–6. https://doi.org/10.1515/cclm-2015-0699.Suche in Google Scholar
9. McTaggart, MP, Lindsay, J, Kearney, EM. Replacing urine protein electrophoresis with serum free light chain analysis as a first-line test for detecting plasma cell disorders offers increased diagnostic accuracy and potential health benefit to patients. Am J Clin Pathol 2013;140:890–7. https://doi.org/10.1309/AJCP25IHYLEWCAHJ.Suche in Google Scholar
10. Marshall, T, Williams, KM. Electrophoretic analysis of Bence Jones proteinuria. Electrophoresis 1999;20:1307–24. https://doi.org/10.1002/(SICI)1522-2683(19990601)20:7<1307::AID-ELPS1307>3.0.CO;2-P.10.1002/(SICI)1522-2683(19990601)20:7<1307::AID-ELPS1307>3.0.CO;2-PSuche in Google Scholar
11. Harrison, HH. The “ladder light chain” or “pseudo-oligoclonal” pattern in urinary immunofixation electrophoresis (IFE) studies: a distinctive IFE pattern and an explanatory hypothesis relating it to free polyclonal light chains. Clin Chem 1991;37:1559–64.10.1093/clinchem/37.9.1559Suche in Google Scholar
12. Graziani, M, Merlini, G, Petrini, C. Guidelines for the analysis of Bence Jones protein. Clin Chem Lab Med 2003;41:338–46. https://doi.org/10.1515/CCLM.2003.054.Suche in Google Scholar
13. Palladini, G, Russo, P, Bosoni, T, Verga, L, Sarais, G, Lavatelli, F, et al.. Identification of amyloidogenic light chains requires the combination of serum-free light chain assay with immunofixation of serum and urine. Clin Chem 2009;55:499–504. https://doi.org/10.1373/clinchem.2008.117143.Suche in Google Scholar
14. Katzmann, JA, Abraham, RS, Dispenzieri, A, Lust, JA, Kyle, RA. Diagnostic performance of quantitative kappa and lambda free light chain assays in clinical practice. Clin Chem 2005;51:878–81. https://doi.org/10.1373/clinchem.2004.046870.Suche in Google Scholar
15. Smith, JD, Raines, G, Schneider, HG. Should routine laboratories stop doing screening serum protein electrophoresis and replace it with screening immune-fixation electrophoresis? No quick fixes: counterpoint. Clin Chem Lab Med 2016;54:967–71. https://doi.org/10.1515/cclm-2015-0806.Suche in Google Scholar
16. Genzen, JR, Murray, DL, Abel, G, Meng, QH, Baltaro, RJ, Rhoads, DD, et al.. Screening and diagnosis of monoclonal gammopathies: an International Survey of Laboratory Practice. Arch Pathol Lab Med 2018;142:507–15. https://doi.org/10.5858/arpa.2017-0128-cp.Suche in Google Scholar
17. Perry, MC, Kyle, RA. The clinical significance of Bence Jones proteinuria. Mayo Clin Proc 1975;50:234–8.Suche in Google Scholar
18. Pezzoli, A, Pascali, E. The clinical significance of pure Bence Jones proteinuria at low concentration. Am J Clin Pathol 1989;91:473–5. https://doi.org/10.1093/ajcp/91.4.473.Suche in Google Scholar
19. Kyle, RA, Greipp, PR. “Idiopathic” Bence Jones proteinuria: long-term follow-up in seven patients. N Engl J Med 1982;306:564–7. https://doi.org/10.1056/nejm198203113061002.Suche in Google Scholar
20. Kyle, RA, Larson, DR, Therneau, TM, Dispenzieri, A, Melton, LJ3rd, Benson, JT, et al.. Clinical course of light-chain smouldering multiple myeloma (idiopathic Bence Jones proteinuria): a retrospective cohort study. Lancet Haematol 2014;1:e28–36. https://doi.org/10.1016/s2352-3026(14)70001-8.Suche in Google Scholar
21. Leung, N, Gertz, M, Kyle, RA, Fervenza, FC, Irazabal, MV, Eirin, A, et al.. Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases. Clin J Am Soc Nephrol 2012;7:1964–8. https://doi.org/10.2215/cjn.11161111.Suche in Google Scholar
22. McTaggart, MP, Lindsay, J, Kearney, EM. Replacing urine protein electrophoresis with serum free light chain analysis as a first-line test for detecting plasma cell disorders offers increased diagnostic accuracy and potential health benefit to patients. Am J Clin Pathol 2013;140:890–7. https://doi.org/10.1309/ajcp25ihylewcahj.Suche in Google Scholar PubMed
23. Rajkumar, SV, Dimopoulos, MA, Palumbo, A, Blade, J, Merlini, G, Mateos, MV, et al.. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014;15:e538–48. https://doi.org/10.1016/s1470-2045(14)70442-5.Suche in Google Scholar
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Reviews
- An overview of mental health during the COVID-19 pandemic
- Potential mechanisms of action of convalescent plasma in COVID-19
- Mini Review
- Gap of knowledge in diagnosis of pyoderma gangrenosum in clinical specialties education
- Opinion Papers
- Learning clinical reasoning from the fictional detectives
- Integrating infection and sepsis management through holistic early warning systems and heuristic approaches: a concept proposal
- (F)utility of urine Bence Jones proteins for “routine” screening for plasma cell dyscrasia
- COVID-19 and the Le Chatelier’s principle
- Original Articles
- Are sniffer dogs a reliable approach for diagnosing SARS-CoV-2 infection?
- Using body temperature and variables commonly available in the EHR to predict acute infection: a proof-of-concept study showing improved pretest probability estimates for acute COVID-19 infection among discharged emergency department patients
- Identifying children at high risk for infection-related decompensation using a predictive emergency department-based electronic assessment tool
- Antecedent treat-and-release diagnoses prior to sepsis hospitalization among adult emergency department patients: a look-back analysis employing insurance claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology
- Rate of sepsis hospitalizations after misdiagnosis in adult emergency department patients: a look-forward analysis with administrative claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology in an integrated health system
- Real-world virtual patient simulation to improve diagnostic performance through deliberate practice: a prospective quasi-experimental study
- Overutilization and underutilization of autoantibody tests in patients with suspected autoimmune disorders
- Postnatal ultrasound follow-up in neonates with prenatal hydronephrosis
- Clinical performance of amperometry compared with enzymatic ultra violet method for lactate quantification in cerebrospinal fluid
- Case Report – Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error
- Case Report
- The COVID trap: pediatric diagnostic errors in a pandemic world
- Letters to the Editor
- Atrial arrhythmia and its association with COVID-19 outcome: a pooled analysis
- Serious game training in medical education: potential to mitigate cognitive biases of healthcare professionals
- Revisiting handoffs: an opportunity to prevent error
Artikel in diesem Heft
- Frontmatter
- Reviews
- An overview of mental health during the COVID-19 pandemic
- Potential mechanisms of action of convalescent plasma in COVID-19
- Mini Review
- Gap of knowledge in diagnosis of pyoderma gangrenosum in clinical specialties education
- Opinion Papers
- Learning clinical reasoning from the fictional detectives
- Integrating infection and sepsis management through holistic early warning systems and heuristic approaches: a concept proposal
- (F)utility of urine Bence Jones proteins for “routine” screening for plasma cell dyscrasia
- COVID-19 and the Le Chatelier’s principle
- Original Articles
- Are sniffer dogs a reliable approach for diagnosing SARS-CoV-2 infection?
- Using body temperature and variables commonly available in the EHR to predict acute infection: a proof-of-concept study showing improved pretest probability estimates for acute COVID-19 infection among discharged emergency department patients
- Identifying children at high risk for infection-related decompensation using a predictive emergency department-based electronic assessment tool
- Antecedent treat-and-release diagnoses prior to sepsis hospitalization among adult emergency department patients: a look-back analysis employing insurance claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology
- Rate of sepsis hospitalizations after misdiagnosis in adult emergency department patients: a look-forward analysis with administrative claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology in an integrated health system
- Real-world virtual patient simulation to improve diagnostic performance through deliberate practice: a prospective quasi-experimental study
- Overutilization and underutilization of autoantibody tests in patients with suspected autoimmune disorders
- Postnatal ultrasound follow-up in neonates with prenatal hydronephrosis
- Clinical performance of amperometry compared with enzymatic ultra violet method for lactate quantification in cerebrospinal fluid
- Case Report – Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error
- Case Report
- The COVID trap: pediatric diagnostic errors in a pandemic world
- Letters to the Editor
- Atrial arrhythmia and its association with COVID-19 outcome: a pooled analysis
- Serious game training in medical education: potential to mitigate cognitive biases of healthcare professionals
- Revisiting handoffs: an opportunity to prevent error
